Teen Eating Disorders
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Geophagia, More Commonly Called Pica

Definition: Pica is an eating disorder typically defined as the persistent eating of nonnutritive substances for a period of at least one month at an age in which this behavior is developmentally inappropriate. The definition is occasionally broadened to include the mouthing of nonnutritive substances.

Individuals presenting with pica have been reported to mouth and/or ingest a wide variety of nonfood substances (Ellis, 2002). The word "pica" comes from the Latin word for Magpie, a bird known for eating anything that it comes across (Support Concern and Resources for Eating Disorders, 2001).

People with pica frequently crave and consume nonfood items such as:
• dirt
• clay
• paint chips
• plaster
• chalk
• cornstarch
• laundry starch
• baking soda
• coffee grounds
• cigarette ashes
• burnt match heads
• cigarette butts
• feces
• ice
• glue
• hair
• buttons
• paper
• sand
• toothpaste
• soap

Although consumption of some items may be harmless, pica is considered to be a serious eating disorder that can sometimes result in serious health problems such as lead poisoning and iron-deficiency anemia.


Pica found around the world:

Pica has been reported in many parts of the world. “In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic (Ellis).” It is known to have been practiced in over 200 cultures around the world. Reasons vary from religious practices, assistance to nursing mothers, and medicinal reasons for illness.

Pica in the U.S.:

The prevalence of pica is unknown in the U.S. This is most likely due to the disorder being undiagnosed and so not reported. Pica is most often reported in children and individuals with mental retardation (however it is also found in other populations such as pregnant women, people living in poverty, people experiencing certain psychiatric disturbances such as hysteria, people dieting and attempting to stave off food cravings by ingesting non-nutritive substances). Children with autism and/or mental retardation have a higher frequency of this disorder than children without these disorders. Pica is the most common eating disorder among individuals with mental retardation. The risk and severity of pica increases with increasing severity of mental retardation. In these individuals it most often occurs between the ages of 10 – 20 years of age.


Complications due to pica:

The complications due to pica depend on what is ingested and in what quantity. Among toxins that tend to be ingested, lead poisoning is the most common. Various parasites can be ingested with non-edible objects. The variety of symptoms that may occur due to ingestion vary greatly. They may be as benign as cold or flu symptoms, or as severe as death. They may occur immediately or may take hours to manifest.

Reasons for pica:

In individuals with mental retardation, one theory postulates that the reason for this disorder is the inability to discriminate between edible items and non-edible items. Another theory suggests that this is a learned behavior, the behavior continuing due to the gratification of the behavior. Another theory postulates that there is a biochemical disorder occurring in the brain of individuals with this disorder.

Treatment of pica:

There is no specific medical treatment for pica. Careful analysis of the behavior can be crucial to effective treatment.

Currently the acknowledged form of treatment is behavior modification. "Among the behavioral strategies that have been effective are antecedent manipulation (preparing the environment and individual in order to avoid non-edible items); discrimination training between edible and nonedible items; self-protection devices that prohibit placement of objects in the mouth; sensory reinforcement; differential resinforcement of other or incompatible behaviors, such as screening (covering eyes briefly), contingent aversive oral tastes, smell sensations, physical sensations, and brief physical restraint; and overcorrection (correct the environment, or practice appropriate alternative responses (Ellis)." This writer suggests using only positive reinforcements and modifications.

It is likely that the best immediate results will happen as staff assures that there are no non-edible items within arm’s reach of the consumer. Remember that any item that can fit in the mouth can be ingested. If ingested, even if the item is not toxic, it may cause choking or other issues if swallowed.

Long-term results will likely include training to discriminate edible from non-edible items.

Prognosis:

In children the problem tends to decrease with age unless the child has mental retardation or a developmental disability. In individuals with mental retardation or developmental disorders, pica may persist for years if untreated.


Bibliography:

American Psychiatric Association: DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision. American Psychiatric Press; 1994.

Anorexia and Related Eating Disorders, Inc. (ANRED). www.anred.com/pica.html. Last updated on 2/02.

Ellis, Cynthia R., MD, Schnoes, Connie Jo, MA. Eating Disorder: Pica. EMedicine. www.emedicine.com/ped/topic1798.htm. Last updated 9/10/02.

Support Concern and Resources for Eating Disorders. www.eating-disorder.org/pica.html. 2001.


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